成本效果分析在中医骨伤科临床研究中的应用
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摘要
目的:了解中医骨伤科随机对照试验中成本效果分析(cost effectiveness analysis,CEA)的研究现状。方法:回顾性分析2000年1月1日至2018年8月31日在中国知网、万方数据库、维普数据库发表的中文期刊文献,评价以中医疗法为主的干预措施治疗骨科疾病的成本效果,观察指标包括CEA评价指标。结果:共纳入RCT文献23篇。研究病种主要涉及颈椎病、骨关节炎、骨质疏松症、腰椎间盘突出症、退行性腰椎失稳症、骨折等。评价的干预措施包括手法、针刺、艾灸、中药等疗法,以及中医、中西医结合等综合疗法。疗效评价主要包括疼痛与临床有效率等指标,CEA评价主要是以直接成本为主的成本效果比。结论:基于现有随机对照试验,CEA研究主要关注骨退变与骨代谢疾病,建议今后研究应选择国际公认的疗效评价指标,成本评价应全面考虑成本构成,选择合适的研究方法开展经济学评价。
Objective: To understand the current status of cost effectiveness analysis(CEA) in randomized controlled trials(RCTs) of traditional Chinese medicine(TCM) orthopedics. Methods: Retrospective analysis was conducted and the published literatures were searched from January 1 st, 2000 to August 31 st, 2018 in CNKI,Wanfang Data, and VIP database. The cost effectiveness of TCM interventions in the treatment of orthopedic diseases was evaluated and the observation indicators included CEA evaluation indexes. Results: A total of 23 RCTs were included. The diseases mainly involved cervical spondylosis, osteoarthritis, osteoporosis, lumbar disc herniation, degenerative lumbar instability, and fractures and so on. Interventions for evaluation included massage/manipulation, acupuncture, moxibustion, and herbal medicine, as well as TCM and integrated traditional Chinese and Western medicine. The pain score scale and clinical effective rate are the common therapeutic evaluation indexes. Cost-effectiveness ratio that mainly includes direct cost is often applied in the CEA evaluation. Conclusion: Based on the existing RCTs, the CEA study focuses on bone degeneration and bone metabolism diseases. It is suggested that internationally recognized therapeutic efficacy evaluation indicators should be selected for future studies. The cost evaluation should fully consider the cost components and select appropriate research methods.
Objective: To understand the current status of cost effectiveness analysis(CEA) in randomized controlled trials(RCTs) of traditional Chinese medicine(TCM) orthopedics. Methods: Retrospective analysis was conducted and the published literatures were searched from January 1 st, 2000 to August 31 st, 2018 in CNKI,Wanfang Data, and VIP database. The cost effectiveness of TCM interventions in the treatment of orthopedic diseases was evaluated and the observation indicators included CEA evaluation indexes. Results: A total of 23 RCTs were included. The diseases mainly involved cervical spondylosis, osteoarthritis, osteoporosis, lumbar disc herniation, degenerative lumbar instability, and fractures and so on. Interventions for evaluation included massage/manipulation, acupuncture, moxibustion, and herbal medicine, as well as TCM and integrated traditional Chinese and Western medicine. The pain score scale and clinical effective rate are the common therapeutic evaluation indexes. Cost-effectiveness ratio that mainly includes direct cost is often applied in the CEA evaluation. Conclusion: Based on the existing RCTs, the CEA study focuses on bone degeneration and bone metabolism diseases. It is suggested that internationally recognized therapeutic efficacy evaluation indicators should be selected for future studies. The cost evaluation should fully consider the cost components and select appropriate research methods.
引文
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[15]黄宏兴,邓崇礼,李颖,等.中药骨康治疗绝经后骨质疏松症卫生经济学分析[J].中国骨质疏松杂志,2008,14(6):391-395.
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[21]谢占国,刘璋,苏梦惟,等.针刺联用抗阻训练治疗中老年退行性腰椎不稳症的比较效果研究[J].针灸临床杂志,2017,33(2):8-12.
[22]许建文,沈茂荣,夏天,等.原发性骨质疏松性胸腰椎骨折的非手术治疗方案比较研究[J].广西中医药大学学报,2012,15(4):7-10.
[23]刘曦,曾宪明,曾桓中,等.伤科接骨片和骨愈灵胶囊口服治疗创伤性骨折的成本-效果分析[J].海峡药学,2016,28(5):76-78.
[24]黄咏红,伍瑞云,覃茂林,等.鹿瓜多肽与复方骨肽治疗四肢骨折的药物经济学研究[J].亚太传统医药,2014,10(4):129-130.
[25]顾联斌,江长缨,范春兰.社区中西医结合康复治疗的卫生经济学评价[J].预防医学,2018,30(2):139-143.
[26]魏戌,高云,谢琪,等.真实世界研究神经根型颈椎病非药物疗法的临床应用[J].世界科学技术—中医药现代化,2017,19(12):1960-1965.
[27]中国中医科学院.中医循证临床实践指南(专科专病)[M].北京:中国中医药出版社,2011:67-89.
[28] Yan H, Su Y, Chen L, et al. Rehabilitation for the management of knee osteoarthritis using comprehensive traditional Chinese medicine in community health centers:study protocol for a randomized controlled trial[J].Trials,2013(14):367.
[29] Haas M,De Abreu Lourenco R. Pharmacological management of chronic lower back pain:a review of cost effectiveness[J].Pharmacoeconomics,2015,33(6):561-569.
[30] Essex H,Parrott S,Atkin K,et al. An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain:A randomized trial(ATLAS)[J].PLoS One,2017,12(12):e0178918.
[31]于嘉,谢雁鸣.影响卫生经济学评价的因素分析[J].中国中医药信息杂志,2009,16(S1):121-123.
[32]徐婷婷,方海.卫生经济学评价指南介绍[J].中国卫生经济,2016,35(5):5-8.
[2]季聪华,曹毅,李秋爽,等.中医临床诊疗指南卫生经济学评价应用方法探讨[J].中华中医药杂志,2016,31(3):910-913.
[3]于嘉,谢雁鸣,朱立国,等.旋转手法治疗神经根型颈椎病成本效果分析[J].中国中医药信息杂志,2008,15(4):7-8.
[4]朱国苗.旋转拔伸手法治疗神经根型颈椎病的临床经济学研究[J].时珍国医国药,2012,23(9):2338-2339.
[5]席智杰,梁倩倩,王拥军,等.耳针治疗颈型颈椎病的成本效果分析[J].针灸临床杂志,2012,28(11):32-38.
[6]贾维刚,程少平,周泉宇,等.基于临床路径的1234取穴法中西医结合治疗颈性眩晕的近期疗效评价及经济学分析[J].黑龙江中医药,2018,45(4):52-54.
[7]范琰,龚伶伶,娄灵芝,等.电针陆氏健膝穴治疗老年膝骨关节炎成本效果分析[J].中国中医药现代远程教育,2011,9(4):46-48.
[8]胡伟民,东贵荣.社区针灸推拿治疗膝关节骨性关节炎成本效果分析[J].中国社区医师,2012,14(6):224,226.
[9]胡晓颖,李璟,李申,等.艾灸治疗膝骨关节炎的成本-效果分析[J].上海针灸杂志,2017,36(9):1025-1028.
[10]邓崇礼,吴少鹏,夏雄智,等.骨筋肉并重特色疗法治疗膝骨关节炎成本效果分析[J].云南中医中药杂志,2013,34(6):80-81.
[11]徐菲,杨克新,刘国恩,等.奇正消痛贴膏治疗骨性关节炎疼痛的药物经济学评价[J].中国全科医学,2017,20(36):4529-4533.
[12]邓伟民,邵玉,黄海,等.补肾壮骨冲剂、密盖息治疗绝经后骨质疏松疼痛的成本-效果分析[J].中国骨质疏松杂志,2008,14(12):896-899.
[13]朱峰,张小骞,陈扬,等.牛淫合剂与阿仑膦酸钠治疗绝经后骨质疏松疼痛的成本-效果分析[J].风湿病与关节炎,2017,6(2):26-28,46.
[14]张蕾,刘晶,刘宝,等.仙灵骨葆治疗绝经后妇女骨质疏松的药物经济学分析[J].中国药物经济学,2017,12(2):9-12.
[15]黄宏兴,邓崇礼,李颖,等.中药骨康治疗绝经后骨质疏松症卫生经济学分析[J].中国骨质疏松杂志,2008,14(6):391-395.
[16]杨晨,罗茂华,黄海,等.老年男性骨质疏松症治疗药物的决策树分析[J].中国药房,2015,26(8):1009-1012.
[17]冯炎林,陈文钦,吴奋飞.仙灵骨葆、福善美联合钙尔奇D治疗骨质疏松的效果比较[J].海峡药学,2013,25(6):163-164.
[18]邓勇.治疗椎间盘疾病中医适宜技术推广应用效果的卫生经济学评价[D].北京:北京中医药大学,2008.
[19]黄晓静.治疗腰椎间盘突出症的三项中医适宜技术的成本效果分析[D].北京:北京中医药大学,2011.
[20]杜晨.电针为主的三种疗法治疗LDH所致坐骨神经痛的临床疗效和卫生经济学评价[D].成都:成都中医药大学,2013:1-2.
[21]谢占国,刘璋,苏梦惟,等.针刺联用抗阻训练治疗中老年退行性腰椎不稳症的比较效果研究[J].针灸临床杂志,2017,33(2):8-12.
[22]许建文,沈茂荣,夏天,等.原发性骨质疏松性胸腰椎骨折的非手术治疗方案比较研究[J].广西中医药大学学报,2012,15(4):7-10.
[23]刘曦,曾宪明,曾桓中,等.伤科接骨片和骨愈灵胶囊口服治疗创伤性骨折的成本-效果分析[J].海峡药学,2016,28(5):76-78.
[24]黄咏红,伍瑞云,覃茂林,等.鹿瓜多肽与复方骨肽治疗四肢骨折的药物经济学研究[J].亚太传统医药,2014,10(4):129-130.
[25]顾联斌,江长缨,范春兰.社区中西医结合康复治疗的卫生经济学评价[J].预防医学,2018,30(2):139-143.
[26]魏戌,高云,谢琪,等.真实世界研究神经根型颈椎病非药物疗法的临床应用[J].世界科学技术—中医药现代化,2017,19(12):1960-1965.
[27]中国中医科学院.中医循证临床实践指南(专科专病)[M].北京:中国中医药出版社,2011:67-89.
[28] Yan H, Su Y, Chen L, et al. Rehabilitation for the management of knee osteoarthritis using comprehensive traditional Chinese medicine in community health centers:study protocol for a randomized controlled trial[J].Trials,2013(14):367.
[29] Haas M,De Abreu Lourenco R. Pharmacological management of chronic lower back pain:a review of cost effectiveness[J].Pharmacoeconomics,2015,33(6):561-569.
[30] Essex H,Parrott S,Atkin K,et al. An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain:A randomized trial(ATLAS)[J].PLoS One,2017,12(12):e0178918.
[31]于嘉,谢雁鸣.影响卫生经济学评价的因素分析[J].中国中医药信息杂志,2009,16(S1):121-123.
[32]徐婷婷,方海.卫生经济学评价指南介绍[J].中国卫生经济,2016,35(5):5-8.
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